Verbal communication disorders in brain damaged post-stroke patients in Benin

AbstractIn Western countries, progress has lessened the severity of numerous sequels of verbal communication disorders (VCD). For Africa and more particularly Benin, few data on the subject are presently available.ObjectiveTo analyze the occurrence and development of post-stroke VCD in Benin.MethodA retrospective, descriptive and analytical study focused on 563 post-stroke patients treated in rehabilitation department of the National university hospital of Cotonou (CNHU) from January 2006 through December 2010.ResultsVCD prevalence was 42.10%. Average age was 57.17±12.62years, sex ratio was 1.75, and 74.69% were right-handed. VCD affected oral expression (95.78%), written expression (2.11%), oral comprehension (13.08%) and written comprehension or reading (0.84%). Type of stroke, sex and age had no impact on VCD occurrence following stroke. Only 5.91% of the patients underwent speech therapy. Progression was favorable in 21.09% of the cases studied.ConclusionIn Benin, post-stroke VCD is exceedingly common and occasions major social difficulties. Prevalence of VCD in a predominantly oral culture underscores the need for speech therapists to develop a more broadly ecological approach toward treatment

Resumption to work after cerebrovascular accident in Cotonou

Stroke affects more and more young and active population. For many survivors, the resumption to work is very complex [1]. The reduction in productivity, which ensues from it because of the sequel is a brake for the development. Restoration of function and rehabilitation are very important to prevent or reduce these sequelae.ObjectiveStudy resumption to work after stroke in Cotonou and factors that influence it.MethodProspective and transversal study, realized from September 5th till December 3rd, 2012. It was about 114 subjects, victims of stroke at least 6 months before the period of study, having an employment before the cerebrovascular accident, not hospitalized during the period of study for stroke or other pathology affecting the prognosis for survival and having consented to participate to this study. The tests of Chi-square, reduced gap and Kruskal-Wallis were used for the statistical analysis.ResultsSubjects are from 30 to 59 years old with an average of 49.4 years. They were for the greater part men (63.2%). 53.5% returned to a professional activity. This work was the same for half of them, without modification of the workstation. Motivating factors of this resumption were boredom (54%), fear of the dismissal (29.5%), need of money (16.4%). For those who did not resume work, the lack of strength was the main reason evoked. The initial profession, the number of children in charge, a depression, the risk of fall and the level of motor FIM influenced the resumption in a professional activity.Discussion and conclusionOccupational reintegration of patients after stroke is complex and requires the collaboration of several participants such as physiotherapist, social worker, employer, company doctor, family, with the patient in the center

Niveau de connaissance des agents de sante sur le positionnement de l’hemiplegique alite au CNHU-HKM de Cotonou

Une bonne installation du patient hémiplégique en phase d’alitement est déterminante pour la prévention de certaines complications de  l’immobilité. Il s’agit de notions qui devaient être bien connues des soignants qui sont aux côtés de ces patients. Nous avons eu pour objectif d’évaluer le niveau de connaissance (NC) des agents de santé (AS) sur le positionnement de l’hémiplégique hospitalisé au CNHU-HKM de Cotonou. Méthode : Etude prospective de type descriptif et analytique, menée de mars à avril 2015, chez les étudiants en fin de formation de médecine générale (internes) ou de soins infirmiers, de même que les médecins en cours de spécialisation en stage dans les services de neurologie et de réanimation du CNHU-HKM de Cotonou et les infirmiers de ces services. A partir de diverses questions, des aspects du positionnement pour divers modes ont été abordés et notés chez ces AS. Leur NC sur le positionnement pour un mode donné a été catégorisé médiocre, passable ou bon selon leur score total de cotation pour ce mode. Résultat : Il s’agit de 115 AS, dont le NC a été médiocre (48-79%) pour les modes assis, décubitus dorsal, décubitus latéral côté sain ou plégique. Les postures des différents segments corporels lors de ces modes de positionnement ont été les moins maîtrisées par ces agents (7,5-54,8%). Le NC du positionnement des AS a été significativement associé à leur statut professionnel (p=0,001-0,004). Conclusion : Le NC des AS, sur le positionnement de l’hémiplégique, reste encore limité à Cotonou. Il est alors déterminant d’insister sur ces notions lors de la formation de ces agents. Mots-clés : Positionnement, hémiplégie, agents de santé, Cotonou.   English Title: Level of knowledge of healthworkers about positioning of hemiplegic patients in the bedrest phase in CNHU-HKM of Cotonou  A good installation of hemiplegic patient in the bed rest phase is decisive to prevent certain complications of immobility. So, these are concepts that must be well known by caregivers of those patients. We aimed to evaluate the level of knowledge (LK) of health workers (HW) on the positioning of hemiplegic patients hospitalized in CNHU-HKM of Cotonou.Method: Prospective study, descriptive and analytical type, conducted from March to April 2015, concerning students at the end of general medicine or nursing, as well as medical doctors in specialities who where at traineeship in neurology and resuscitation departments of the CNHU-HKM of Cotonou and nurses of these services. With certain questions, aspects of positioning for various modes were examined in these HW group. Their LK on positioning for a given mode was categorized as poor, meedle or good based on their total scoring for that mode.Result: It was 115 HW, whose LK was poor (48-79%) for the seated, supine, lateral decubitus on healthy or paresis side. Postures of the different body segments during these positioning modes were the least known by these agents (7.5-54.8%). The LK of HW positioning was significantly associated with their occupational status (p = 0.001-0.004).Conclusion : The LK of HW, about positioning of hemiplegic patients, remain to be limit in Cotonou. So, itis important to insist on those concepts during the initial formation of HW. Key-words : Positioning, hemiplegic patient, health workers, Cotonou

Evaluation of manual ability in stroke patients in Benin: cultural adaptation and Rasch validation of the ABILHAND-Stroke questionnaire.

ABILHAND is a self-reported questionnaire assessing manual ability. It was validated and calibrated using the Rasch analysis for European stroke patients. After a stroke, performing upper limb activities of daily living is influenced by personal and environmental contextual factors. It is thus important to conduct a contextual validation to use this questionnaire outside of Europe. To perform a cross cultural validation of the ABILHAND-Stroke questionnaire for post- stroke patients living in Benin, a West-African country. Observational cross-sectional study. Outpatient rehabilitation centres. 223 Beninese chronic stroke patients. The experimental questionnaire was made of 59 items evaluating manual activities. Patients had to estimate their difficulty of performing each activity according to four response categories: impossible, very difficult, difficult and easy. For construct validity analysis, patients were also evaluated with other assessment tools: Box and Block Test, the motor subscale of the Functional Independence Measure, the Stroke Impairment Assessment Set, and ACTIVLIM- Stroke. Data were analysed with the Rasch partial credit model. The response categories very difficult and difficult were merged and the number of response categories was reduced from 4 to 3 (impossible, difficult and easy). The Rasch analyses selected 16 bimanual activities that fit the Rasch model (chi square=42.35; p=0.10). The item location ranged from -1.10 to 2.24 logits. The standard error ranged from 0.15 to 0.22 logits. There is no differential item functioning between subgroups (age, sex, dexterity, affected side, time since stroke). The person separation index is 0.82. The questionnaire can measure 3 levels of manual ability, similarly to the occidental version. The ABILHAND-stroke is a Rasch validated, unidimensional and invariant questionnaire to assess manual ability among Beninese patients. The ordinal score can be transformed into linear score using a conversion table. This assessment tool is clinically relevant in Benin, a developing country, since it requires no specific equipment or training. It should promote and standardize assessments for stroke patients in clinical practice and research in this African country